Investigation of endovascular recanalization for symptomatic non-acute intracranial artery occlusion

doi:10.3969/j.issn.1672-6731.2020.06.009

Abstract

Abstract:

Objective To explore the feasibility, effectiveness and safety of endovascular recanalization of symptomatic non-acute intracranial artery occlusion (SNIATO). Methods Sixty-one patients with SNIATO from December 2008 to August 2019 were enrolled. All patients underwent endovascular recanalization. Thrombolysis Cerebral Infarction (TICI) was used to evaluate the recanalization rate and record perioperative complications. For complications during surgery, the prognosis was evaluated by modified Rankin Scale (mRS). The arterial restenosis was observed by DSA. Results Fifty-three (86.89%) of 61 patients had successful recanalization, while 8 (13.11%) had failed recanalization. Among the 8 patients, 4 cases failed to pass through the occluded segment with the microwire gave up the operation, one patient died of branch artery bleeding caused by puncture of microwire and was ruptured, and 3 cases died of intracranial hemorrhage (ICH) caused by postoperative cerebral hyperperfusion syndrome (CHS). Fifty-three patients with successful recanalization had improved postoperative clinical symptoms and completed 6-24 months for follow-up. Forty-four patients had a good prognosis, 6 had a moderate prognosis, and 3 had a poor prognosis. Arterial restenosis occurred in 4 patients with no clinical symptoms. Conclusions Endovascular recanalization for SNIATO is technically feasible, and the efficacy is positive. The long-term prognosis is good, but the requirements for neurointerventional technology are high. The surgeon must have some technical reserve and clinical experience. During the perioperative period, the doctor must have the ability to manage and treat the complications to cooperate between the treatment team and the nursing team.

Key words: Arterial occlusive diseases, Intracranial arterial diseases, Angioplasty, Intraoperative complications, Prognosis

摘要：

目的初步探讨症状性非急性颅内动脉闭塞血管再通治疗的可行性、有效性和安全性。方法纳入2008年12月至2019年8月接受血管再通治疗的61例症状性非急性颅内动脉闭塞病例，脑梗死溶栓血流分级（TICI）评价血管再通率、记录围手术期并发症，改良Rankin量表（mRS）评价预后、DSA观察动脉再狭窄率。结果 53例（86.89%）血管再通成功、8例（13.11%）血管再通失败，4例微导丝无法通过闭塞段而放弃手术、1例微导丝刺破穿支动脉致破裂出血死亡、3例术后脑高灌注综合征致颅内出血死亡。53例术后临床症状均明显改善，随访6~24个月，预后良好44例、预后中等6例、预后不良3例；4例发生动脉再狭窄，但均无临床症状。结论症状性非急性颅内动脉闭塞的血管再通治疗在技术上可行，且疗效肯定，远期预后良好，但神经介入技术要求较高，术者需具备一定的技术储备和临床经验，以及围手术期管理能力和并发症处理能力，同时需要良好的治疗团队与护理团队精诚合作。

关键词: 动脉闭塞性疾病, 颅内动脉疾病, 血管成形术, 手术中并发症, 预后

FENG Zhen-guang, WANG Chen, SHENG Zhi-guo, ZHOU Bao-sheng, YANG Fan, CHANG Bin-ge. Investigation of endovascular recanalization for symptomatic non-acute intracranial artery occlusion[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2020, 20(6): 519-527.

冯振广, 王晨, 盛志国, 周宝生, 杨帆, 常斌鸽. 症状性非急性颅内动脉闭塞血管再通治疗探讨[J]. 中国现代神经疾病杂志, 2020, 20(6): 519-527.

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